Provider Demographics
NPI:1316352198
Name:RAIMONDO, NICOLE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RAIMONDO
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S CONKLING ST # B500
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5341
Mailing Address - Country:US
Mailing Address - Phone:914-646-5773
Mailing Address - Fax:
Practice Address - Street 1:1684 E GUDE DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5338
Practice Address - Country:US
Practice Address - Phone:914-646-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered